Completed

Updated: November 2, 2020

What are the different tests available to detect COVID-19, and how do they compare in terms of accuracy? How are the results reported back to the public and in what detail?

Summary

The following is a summary of evidence sources that provide information on the current approaches and methods for detecting COVID-19, the accuracy of the tests, and how test results are reported to those who have been tested. For additional information about each of the sources, see the Table below.  For additional information about each of the sources, see the Table below.

The CDC, the Government of Ontario, the Eastern Ontario Health Unit and Toronto Public Health provide the following guidance for gyms and fitness facilities: 1) enforce the use of masks (except while engaging in specific types of physical activity); 2) increase the frequency of disinfection of the facility and equipment between use and remove items that are difficult to clean; 3) ensure a physical distance of at least two metres is maintained between all individuals, facilitated by the modification of equipment arrangement and visual cues/markers and signage; 4) enforce a distance greater than two meters in areas where patrons are engaged in high intensity exercise; 5) suspend the use of towel services; and 6) install physical barriers at front desks [1,4,5,6].

Evidence

What‘s Trending on Social Media and Media

Global News released an article to help individuals differentiate between the three types of coronavirus tests. 
 
CTV news released an article regarding a new study released by Western University and the University of Alberta that could lead to the development of a new cost-effective screening tool for COVID-19. The research looked at using metabolic concentrations in blood as a potential biomarker for COVID-19 in rapid tests. 

Organizational Scan

Public Health Ontario created a page outlining testing guidelines for COVID-19. This page includes information on test methods, specimen collection and handling, and test frequency and turnaround time.[9] 
 
Public Health Ontario created a chart providing information on collection kits for procurement that are acceptable for COVID-19 PCR testing in the province. Find the link here.[10] 

Review of Evidence

Resource Type/Source of Evidence Last Updated
Testing devices for COVID-19: Home testing devices
— Government of Canada
National Guidance

This guidance states that the use of point-of-care tests can be simpler to use and can facilitate faster test results. These tests are to be used in doctor’s offices, pharmacies or at the bedside. As of September 30, 2020, three point-of-care tests for SARS-CoV-2 were available in Canada.  

Last Updated: September 24, 2020
The Role of Different Types of Tests in the COVID-19 Pandemic
— CADTH: Canadian Agency for Drugs and Technologies in Health
National Guidance

This guidance describes that PCR-based testing detects COVID-19 virus genetic material (RNA). In Canada, a variety of different PCR-based tests are available, although a nose or throat swab is most typical. PCR-based testing is used to diagnose active COVID-19 cases and therefore facilitate case identification, isolation, treatment and contact tracing. Serologic tests measure the level of antibodies of COVID-19 in a person’s blood. Antibodies are the proteins produced by the immune system to protect your body from infection and are not present until later in the course of an infection. Serologic tests can show who has been exposed to COVID-19. 

Last Updated: May 31, 2020
Coronavirus Testing Basics
— U.S. Food & Drug Administration
National Guidance

This guidance states that there are 3 types of tests available for COVID-19. A real-time polymerase chain reaction (RT-PCR) test that detects virus’s genetic material, an antigen test that detects specific proteins on the surface of the virus, and an antibody test that looks for antibodies that are made by your immune system in response to a specific virus. Antigen tests usually provide the results on an active infection faster than a PCR test but have a higher chance of missing an active infection. 

Last Updated: July 15, 2020
The Use of Alternate Specimen Collection Methods for COVID-19 PCR Testing
— Public Health Ontario
Provincial Guidance

This guidance states that nasopharyngeal (NP) specimens are the gold standard collection method for COVID-19 PCR testing. Combined swab or throat with anterior nares, or deep nasal specimens are recommended as alternatives to NP specimens. Saliva specimens is slightly less accurate, but still has an acceptable sensitivity, particularly within the first 7 days of symptom onset. Combined throat swab with nares, throat specimens and saliva specimens can be collected by a broader range of health professionals or can be self-administered. No single test provides 100% sensitivity, and a negative test result should be taken in context with the patient's signs, symptoms and exposure history.  

Last Updated: September 14, 2020
Serology testing and COVID-19 – What We Know So Far
— Public Health Ontario
Provincial Guidance

This guidance states that serologic assays detect an antibody response to COVID-19 in a given sample to determine if there is any prior exposure. This is done by detecting immunoglobulin A (IgA), IgM, IgG, and/or the gold standard in serological testing, functional humoral antibody. Both IgA and IgM are markers for early infection; antibodies are detectable from the first week of symptoms up to 32 days after. While it is known that IgG is a marker in infected individuals three weeks after the onset of symptoms it is not known how long IgG persists. Serologic assays used to detect the presence of antibodies (IgM, IgA, IgG) have varying results for sensitivity and specificity depending on the manufacturer. However, studies have inconclusive data that the presence of antibodies will result in immunity to coronavirus antigens 100% of the time. Due to the variable test performance and lack of information, serologic assays can only determine past exposure to COVID-19. 

Last Updated: June 6, 2020
Access COVID-19 Test Results
— Government of Ontario
Provincial Guidance

The Government of Ontario notes that upon getting a COVID-19 test, this website uses the details such as one's health card number and date of birth for individuals to receive test results. Results can take up to four days with the following information:  1) when and where a patient was tested; 2) the patient’s results; and 3) how to proceed based on the results. If you test positive, the guidance states the individual must: 1) self-isolate immediately; 2) await a call from the local Public Health Unit within a few days; 3) create a list of places and people the individual has had contact with to help with Public Health contact tracing; and if you should request a one-time code to enter to the COVID Alert mobile app to notify contacts immediately of potential exposure through the app. 

Last Updated: November 2, 2020
Serology-based tests for COVID-19
— Johns Hopkins Center for Health Security
Professional Organization Guidance

Johns Hopkins Center for Health Security notes that the effectiveness of tests is classified by the sensitivity and specificity of the test. A test with a high sensitivity should correctly identify all truly positive cases, while a test with a high specificity should correctly identify all truly negative cases.  

Last Updated: October 15, 2020
Assessing the Impact of a Training Initiative for Nasopharyngeal and Oropharyngeal Swabbing for COVID-19 Testing
— Abud et al.
Single Study

This study assesses the accuracy and reliability of self-administered specimens for COVID-19. Participants were provided with an instructional video on how to provide a nasopharyngeal and oropharyngeal self-administered swab and a live demonstration. After trainings, swabbing execution was high. Training videos can be used to optimize procedural technique.  

Last Updated: August 13, 2020
Coronavirus Disease 1029 (COVID-19) -PCR
— Public Health Ontario
Organizational Scan Last Updated: October 4, 2020
COVID-19 PCR Collection Kits
— Public Health Ontario
Organizational Scan Last Updated: September 10, 2020
Disclaimer: The summaries provided are distillations of reviews that have synthesized many individual studies. As such, summarized information may not always be applicable to every context. Each piece of evidence is hyperlinked to the original source.

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